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Author Topic: Fulkerson Osteotomy  (Read 1173 times)

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Offline hedurhamel

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Fulkerson Osteotomy
« on: October 15, 2019, 03:51:13 AM »
Hello World of Kneeguru!  :)

After ending up on page 6 of Google trying to gain perspective on what to expect when recovering from a Fulkerson Osteotomy (Tibial Tubercle Osteotomy) surgery, I ended up discovering Knee Guru. I'm hoping someone who has gone through the procedure can shed some light on what to expect and let me know how the surgery went for them.

I also have not found anyone who have had a bilateral procedure? I'm currently planning on having one and would love to hear from someone who has needed the surgery on both knees and if they chose to do it simultaneously or space it out?

To give more context, I'm 23 years old and I've had patella tracking issues since I was about 12 years old for my right knee. The same issue in the left knee since I was 16. I endure patella subluxation 5-8 times a years. Depending on how badly my patella dislocates, I am unable to walk from a few hours to a few days. Most recently, I slipped and fell at work and dislocated both patellas simultaneously for the first time ever. This landed me a trip to the ER, a week off my feet and forced me to revisit the problem I've been avoiding for years.

After a MRI and X-Ray of both knees, the surgeon suggested a Fulkerson Osteotomy. Apparently this most recent dislocation lead to loose bodies in the right knee which needs to be removed. He warned me that I should deal with this while I'm young and can recover quickly. Not happy with the news, I traveled home to Florida and got a second opinion from an OS that's friends with my dad (who is an OS himself) and got a second opinion. He concluded that I need the surgery and that it'd be best to start with the right knee.

After some consideration, he's suggesting that I do them both simultaneously since I don't live in Florida anymore and have approvals to spend 3-6 month in Florida for recovery from work. I've been going crazy doing copious amount of research trying to figure out whether to do both knees or just the right one. Please comment your experiences, thoughts and considerations.

I'll be sure to post updated after I go under the knife on 11/11/19.

Offline kczech

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Re: Fulkerson Osteotomy
« Reply #1 on: November 05, 2019, 04:35:08 AM »
Hey there! Really sorry to hear about your situation, especially at such a young age (like me, I'm 25). While I don't have experience myself with TTT, it was something that my OS and I considered in conjunction with other procedures I had done. I've never had full dislocations, but the cartilage on my patellas is pretty shot from maltracking while I have been fairly active over the past several years. Two weeks ago, I had a proximal tibia osteotomy to address my torsional and varus malalignments which seemed to be at the root of my issues (mine is the only other recently active diary if you'd like to read more). I know it's not the same thing as your surgery, but I couldn't imagine having to go through with both legs at the same time. I originally thought I wanted to do both at the same time, but I'm glad I didn't. Right now, I'm planning to have the other leg done in another 4 months or so. Yours may very well be a lot easier to deal with though. It would be worth asking if you will be weight bearing right away, how long you would be on crutches, what kind of movement restrictions, etc.

Do you know what your TT-TG measurement is? Just curious. Mine on the left is ~17mm (normal being 10-15 from my understanding) and we decided not to move the tubercle in my case because it is fairly close to the norm.
L. Tibia derotational and medial open wedge osteotomy - Oct. 23, '19

"It is not the mountain we conquer, but ourselves." -Edmund Hillary

Offline hedurhamel

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Re: Fulkerson Osteotomy
« Reply #2 on: November 07, 2019, 03:31:15 PM »
Hey Kczech,

Thank you for the kind response and concern. I hope your recovery is going smoothly and you're on track to conquer more 14ers (read your diary)!

My surgery is set for 11/11/19, but after reviewing options with my OS we decided to move forward with just starting with one knee (the right one). I also got insight to all the lovely procedures he's performing on my knee:
  • Right knee arthroscopy to remove loose body
  • Lateral Release
  • Open Fulkerson Osteotomy
  • Open VMO Advancement

My TT-TG is ~20mm on both knees, might be why he's opting to move the tubercle haha. Depending on what recovery is like I'm either going to get the left knee done on 1/2020 or 11/2020.

Please keep updating your recovery diary! You got this, it'll hopefully all be worth it in the end. :)

Offline kczech

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Re: Fulkerson Osteotomy
« Reply #3 on: November 10, 2019, 12:32:28 AM »
Thank you for the well wishes. It has been a goal of mine for many years to climb all the 14ers in the lower 48, so I sure hope you're right! It sucks that things like this hold us back from experiencing life to the fullest, but I use that as motivation for getting through my recovery, and I hope you're able to do the same!

Seems like a fairly potent combination of procedures. Patellar instability is such a multifaceted issue and there's never any one right answer for solving it, but I hope that is what's right for you and I wish you the best!

I look forward to following your recovery as well :)
L. Tibia derotational and medial open wedge osteotomy - Oct. 23, '19

"It is not the mountain we conquer, but ourselves." -Edmund Hillary

Offline hedurhamel

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Re: Fulkerson Osteotomy
« Reply #4 on: November 14, 2019, 04:51:31 PM »
First Night Post-Op:

My boyfriend is a sweetheart and let me have his adjustable bed, the ones that you can elevate the back and the feet and it has been a life saver. I am a side sleeper and sleeping on your back is easier with elevation. This also allows me to have the leg constantly elevated which helps with pain/inflammation.

I started feeling pain so I took another oxy at 8 PM and copious amount of pills at 11 PM. They prescribed me strong Tylenol, oxy, zorin (nausea meds), a nerve pain med and a stool softener.

After that I was pretty zonked and knocked out right away. I woke up at 5 AM to retake all my meds and couldnít fall back asleep. I talked my poor dads ear off for 2 hours and he joked that he thought the pills would knock me out, but instead he feels like I just had 2 martinis haha.

Offline hedurhamel

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Re: Fulkerson Osteotomy
« Reply #5 on: November 20, 2019, 07:45:42 PM »
1 Week Post Op

It's now been a little bit over a week post op, 9 days to be exact. It's been an absolute rollercoaster. A recap of the experience thus far:

Day 1
Day 1 was pretty great and I have the lovely nerve block to thank for that. The pain was there, but between the block and the pain medicine, I was in pretty good spirits. I had pretty good control of the leg and could do leg lifts. The medication made me pretty drowsy, so I slept a lot that day.

Day 2+3
A lot less fun, the leg hurt pretty bad. Stayed in bed for most of the day watching TV. I was supposed to have my first PT appointment on day 3 which I was looking forward to, but the doctor called and cancelled. I changed my dressing for the first time and saw the doctorís artwork. Surprisingly I wasnít very swollen or bruised.

Day 3+4
At this point the pain meds were making me feel sick to my stomach and I was loosing my appetite. My stomach was hurting more than my leg due to not being able to use the bathroom. At this point I decided to stop taking the Oxycontin.

Day 5
Withdrawal symptoms from the Oxy, felt like I had a cold or flu without the fever. I took my first shower today which involved a couple of family members, a shower chair and a trash bag. It felt amazing to be clean. Changed my dressings again and the swelling was still not as bad as I anticipated.

Day 6
I could finally use the bathroom and felt so much better! Had visitors, spent time in the living room instead of being straight on bed rest. Walked around my house in the walker to get the body moving.

Day 7
First post op appointment! Also first time leaving the house in a full week, Iíd never been happier to feel the sun on my skin and breathe fresh air. At the doctor I got my stitches removed and X-Rayed. Hereís a photo of the x-ray and the arthroscopic removal of a loose body I had stuck near the knee cap. They said everything was looking good! My OS said my surgery was very easy and only took him an hour since Iím on the thinner side.

The bad news is that they donít want me to bend the knee or start any kind of PT until my next follow-up appointment...which isnít for another 2 weeks! The PA said that itís normal protocol but from everything Iíve read, it seems like most people start PT the same week or the following week of surgery. Or at least starts working on ROM. I questioned the PA a lot to the point where I feel bad for being a little annoying.

Anyone else whoís had a fulkerson osteotomy - when did you start PT and working on ROM? Their reasoning is that they want the bone to heal more before working on bending. My concern is that the leg is already feeling so stiff and weak, I fear that PT is going to be twice as hard with 3 week of complete immobility.

Day 8+9
Iíve had lots of visitors come over to visit, which has helped with the stir craziness. Iíve also been sitting outside a lot which has been nice. It's very frustrating not being able to move the leg by myself. Iíve started practicing lifting the operated leg with the good leg to get up by myself, but the majority of the time I need someone to physically lift the leg to get up.

Biggest concern is definitely the lack of mobility in the leg, is this normal or am I being dramatic? I'm debating doing some small exercises myself to help with the quad since the doctor is delaying PT.















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